NU 518 Exam 3 Study Guide | Questions and Answers (Complete Solutions)

NU 518 Exam 3 Study Guide | Questions and Answers (Complete Solutions) A 35-year-old archaeologist comes to your office (located in Phoenix, Arizona) for a regular skin check-up. She has just returned from her annual dig site in Greece. She has fair skin and reddish-blonde hair. She has a family history of melanoma. She has many freckles scattered across her skin. From this description, which of the following is not a risk factor for melanoma in this patient? A) Age B) Hair color C) Actinic lentigines D) Heavy sun exposure You are speaking to an 8th grade class about health prevention and are preparing to discuss the ABCDEs of melanoma. Which of the following descriptions correctly defines the ABCDEs? A) A = actinic; B = basal cell; C = color changes, especially blue; D = diameter >6 mm; E =evolution B) A = asymmetry; B = irregular borders; C = color changes, especially blue; D = diameter >6 mm; E = evolution C) A = actinic; B = irregular borders; C = keratoses; D = dystrophic nails; E = evolution D) A = asymmetry; B = regular borders; C = color changes, especially orange; D = diameter >6 mm; E = evolution You are beginning the examination of the skin on a 25-year-old teacher. You have previously elicited that she came to the office for evaluation of fatigue, weight gain, and hair loss. You strongly suspect that she has hypothyroidism. What is the expected moisture and texture of the skin of a patient with hypothyroidism? A) Moist and smooth B) Moist and rough C) Dry and smooth D) Dry and rough A 28-year-old patient comes to the office for evaluation of a rash. At first there was only one large patch, but then more lesions erupted suddenly on the back and torso; the lesions itch. On physical examination, you note that the pattern of eruption is like a Christmas tree and that there are a variety of erythematous papules and macules on the cleavage lines of the back. Based on this description, what is the most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema A 19-year-old construction worker presents for evaluation of a rash. He notes that it started on his back with a multitude of spots and is also on his arms, chest, and neck. It itches a lot. He does sweat more than before because being outdoors is part of his job. On physical examination, you note dark tan patches with a reddish cast that has sharp borders and fine scales, scattered more prominently around the upper back, chest, neck, and upper arms as well as under the arms. Based on this description, what is your most likely diagnosis? A) Pityriasis rosea B) Tinea versicolor C) Psoriasis D) Atopic eczema A 68-year-old retired farmer comes to your office for evaluation of a skin lesion. On the right temporal area of the forehead, you see a flattened papule the same color as his skin, covered by a dry scale that is round and feels hard. He has several more of these scattered on the forehead, arms, and legs. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma A 58-year-old gardener comes to your office for evaluation of a new lesion on her upper chest. The lesion appears to be "stuck on" and is oval, brown, and slightly elevated with a flat surface. It has a rough, wartlike texture on palpation. Based on this description, what is your most likely diagnosis? A) Actinic keratosis B) Seborrheic keratosis C) Basal cell carcinoma D) Squamous cell carcinoma A 72-year-old teacher comes to a skilled nursing facility for rehabilitation after being in the hospital for 6 weeks. She was treated for sepsis and respiratory failure and had to be on the ventilator for 3 weeks. You are completing your initial assessment and are evaluating her skin condition. On her sacrum there is full-thickness skin loss that is 5 cm in diameter, with damage to the subcutaneous tissue. The underlying muscle is not affected. You diagnose this as a pressure ulcer. What is the stage of this ulcer? A) Stage 1 B) Stage 2 C) Stage 3 D) Stage 4 An 8-year-old girl comes with her mother for evaluation of hair loss. She denies pulling or twisting her hair, and her mother has not noted this behavior at all. She does not put her hair in braids. On physical examination, you note a clearly demarcated, round patch of hair loss without visible scaling or inflammation. There are no hair shafts visible. Based on this description, what is your most likely diagnosis? A) Alopecia areata B) Trichotillomania C) Tinea capitis D) Traction alopecia A mother brings her 11 month old to you because her mother-in-law and others have told her that her baby is jaundiced. She is eating and growing well and performing the developmental milestones she should for her age. On examination you indeed notice a yellow tone to her skin from head to toe. Her sclerae are white. To which area should your next questions be related? A) Diet B) Family history of liver diseases C) Family history of blood diseases D) Ethnicity of the child A new mother is concerned that her child occasionally "turns blue." On further questioning, she mentions that this is at her hands and feet. She does not remember the child's lips turning blue. She is otherwise eating and growing well. What would you do now? A) Reassure her that this is normal B) Obtain an echocardiogram to check for structural heart disease and consult cardiology C) Admit the child to the hospital for further observation D) Question the validity of her story You are examining an unconscious patient from another region and notice Beau's lines, a transverse groove across all of her nails, about 1 cm from the proximal nail fold. What would you do next? A) Conclude this is caused by a cultural practice. B) Conclude this finding is most likely secondary to trauma. C) Look for information from family and records regarding any problems which occurred 3 months ago. D) Ask about dietary intake. Dakota is a 14-year-old boy who just noticed a rash at his ankles. There is no history of exposure to ill people or other agents in the environment. He has a slight fever in the office. The rash consists of small, bright red marks. When they are pressed, the red color remains. What should you do? A) Prescribe a steroid cream to decrease inflammation. B) Consider admitting the patient to the hospital. C) Reassure the parents and the patient that this should resolve within a week. D) Tell him not to scratch them, and follow up in 3 days. Mrs. Hill is a 28-year-old African-American with a history of SLE (systemic lupus erythematosus). She has noticed a raised, dark red rash on her legs. When you press on the rash, it doesn't blanch. What would you tell her regarding her rash? A) It is likely to be related to her lupus. B) It is likely to be related to an exposure to a chemical. C) It is likely to be related to an allergic reaction. D) It should not cause any problems. Jacob, a 33-year-old construction worker, complains of a "lump on his back" over his scapula. It has been there for about a year and is getting larger. He says his wife has been able to squeeze out a cheesy-textured substance on occasion. He worries this may be cancer. When gently pinched from the side, a prominent dimple forms in the middle of the mass. What is most likely? A) An enlarged lymph node B) A sebaceous cyst C) An actinic keratosis D) A malignant lesion A young man comes to you with an extremely pruritic rash over his knees and elbows which has come and gone for several years. It seems to be worse in the winter and improves with some sun exposure. On examination, you notice scabbing and crusting with some silvery scale, and you are observant enough to notice small "pits" in his nails. What would account for these findings? A) Eczema B) Pityriasis rosea C) Psoriasis D) Tinea infection Mrs. Anderson presents with an itchy rash which is raised and appears and disappears in various locations. Each lesion lasts for many minutes. What most likely accounts for this rash? A) Insect bites B) Urticaria, or hives C) Psoriasis D) Purpura Ms. Whiting is a 68-year-old who comes in for her usual follow-up visit. You notice a few flat red and purple lesions, about 6 centimeters in diameter, on the ulnar aspect of her forearms but nowhere else. She doesn't mention them. They are tender when you examine them. What should you do? A) Conclude that these are lesions she has had for a long time. B) Wait for her to mention them before asking further questions. C) Ask how she acquired them. D) Conduct the visit as usual for the patient. A middle-aged man comes in because he has noticed multiple small, blood-red, raised lesions over his anterior chest and abdomen for the past several months. They are not painful and he has not noted any bleeding or bruising. He is concerned this may be consistent with a dangerous condition. What should you do? A) Reassure him that there is nothing to worry about. B) Do laboratory work to check for platelet problems. C) Obtain an extensive history regarding blood problems and bleeding disorders. D) Do a skin biopsy in the office. The nurse educator is preparing an education module for the nursing staff on the epidermal layer of skin. Which of these statements would be included in the module? The epidermis is: a Highly vascular. B Thick and tough. C Thin and nonstratified D Replaced every 4 weeks. The nurse educator is preparing an education module for the nursing staff on the dermis layer of skin. Which of these statements would be included in the module? The dermis: a Contains mostly fat cells. b Consists mostly of keratin. c Is replaced every 4 weeks. d Contains sensory receptors. The nurse is examining a patient who tells the nurse, I sure sweat a lot, especially on my face and feet but it doesn’t have an odor. The nurse knows that this condition could be related to: a Eccrine glands. b Apocrine glands. c Disorder of the stratum corneum. d Disorder of the stratum germinativum. A newborn infant is in the clinic for a well-baby checkup. The nurse observes the infant for the possibility of fluid loss because of which of these factors? a Subcutaneous fat deposits are high in the newborn. b Sebaceous glands are over productive in the newborn. c The newborns skin is more permeable than that of the adult. d The amount of vernix caseosa dramatically rises in the newborn. The nurse is bathing an 80-year-old man and notices that his skin is wrinkled, thin, lax, and dry. This finding would be related to which factor in the older adult? a Increased vascularity of the skin b Increased numbers of sweat and sebaceous glands c An increase in elastin and a decrease in subcutaneous fat d An increased loss of elastin and a decrease in subcutaneous fat During the aging process, the hair can look gray or white and begin to feel thin and fine. The nurse knows that this occurs because of a decrease in the number of functioning: a Metrocytes. b Fungacytes. c Phagocytes. d Melanocytes. During an examination, the nurse finds that a patient has excessive dryness of the skin. The best term to describe this condition is: a Xerosis. b Pruritus. c Alopecia. d Seborrhea. A 22-year-old woman comes to the clinic because of severe sunburn and states, I was out in the sun for just a couple of minutes. The nurse begins a medication review with her, paying special attention to which medication class? a Nonsteroidal antiinflammatory drugs for pain b Tetracyclines for acne c Proton pump inhibitors for heartburn d Thyroid replacement hormone for hypothyroidism A woman is leaving on a trip to Hawaii and has come in for a checkup. During the examination the nurse learns that she has diabetes and takes oral hypoglycemic agents. The patient needs to be concerned about which possible effect of her medications? a Increased possibility of bruising b Skin sensitivity as a result of exposure to salt water c Lack of availability of glucose-monitoring supplies d Importance of sunscreen and avoiding direct sunlight A 13-year-old girl is interested in obtaining information about the cause of her acne. The nurse should share with her that acne: a Is contagious. b Has no known cause. c Is caused by increased sebum production. d Has been found to be related to poor hygiene. A 75-year-old woman who has a history of diabetes and peripheral vascular disease has been trying to remove a corn on the bottom of her foot with a pair of scissors. The nurse will encourage her to stop trying to remove the corn with scissors because: a The woman could be at increased risk for infection and lesions because of her chronic disease. b With her diabetes, she has increased circulation to her foot, and it could cause severe bleeding. c She is 75 years old and is unable to see; consequently, she places herself at greater risk for self-injury with the scissors. d With her peripheral vascular disease, her range of motion is limited and she may not be able to reach the corn safely. The nurse keeps in mind that a thorough skin assessment is extremely important because the skin holds information about a persons: a Support systems. b Circulatory status. c Socioeconomic status. d Psychological wellness. A patient comes in for a physical examination and complains of freezing to death while waiting for her examination. The nurse notes that her skin is pale and cool and attributes this finding to: a Venous pooling. b Peripheral vasodilation. c Peripheral vasoconstriction. d Decreased arterial perfusion. A patient comes to the clinic and tells the nurse that he has been confined to his recliner chair for approximately 3 days with his feet down and he asks the nurse to evaluate his feet. During the assessment, the nurse might expect to find: a Pallor b Coolness c Distended veins d Prolonged capillary filling time A patient is especially worried about an area of skin on her feet that has turned white. The health care provider has told her that her condition is vitiligo. The nurse explains to her that vitiligo is: a Caused by an excess of melanin pigment b Caused by an excess of apocrine glands in her feet c Caused by the complete absence of melanin pigment d Related to impetigo and can be treated with an ointment A patient tells the nurse that he has noticed that one of his moles has started to burn and bleed. When assessing his skin, the nurse pays special attention to the danger signs for pigmented lesions and is concerned with which additional finding? a Color variation b Border regularity c Symmetry of lesions d Diameter of less than 6 mm A patient comes to the clinic and states that he has noticed that his skin is redder than normal. The nurse understands that this condition is due to hyperemia and knows that it can be caused by: a Decreased amounts of bilirubin in the blood b Excess blood in the underlying blood vessels c Decreased perfusion to the surrounding tissues d Excess blood in the dilated superficial capillaries During a skin assessment, the nurse notices that a Mexican-American patient has skin that is yellowish-brown; however, the skin on the hard and soft palate is pink and the patients scleras are not yellow. From this finding, the nurse could probably rule out: a Pallor b Jaundice c Cyanosis d Iron deficiency A black patient is in the intensive care unit because of impending shock after an accident. The nurse expects to find what characteristics in this patients skin? a Ruddy blue. b Generalized pallor. c Ashen, gray, or dull. d Patchy areas of pallor. An older adult woman is brought to the emergency department after being found lying on the kitchen floor for 2 days; she is extremely dehydrated. What would the nurse expect to see during the examination? a Smooth mucous membranes and lips b Dry mucous membranes and cracked lips c Pale mucous membranes d White patches on the mucous membranes A 42-year-old woman complains that she has noticed several small, slightly raised, bright red dots on her chest. On examination, the nurse expects that the spots are probably: a Anasarca. b Scleroderma. c Senile angiomas. d Latent myeloma. A 65-year-old man with emphysema and bronchitis has come to the clinic for a follow-up appointment. On assessment, the nurse might expect to see which finding? A Anasarca B Scleroderma C Pedal erythema d Clubbing of the nails A newborn infant has Down syndrome. During the skin assessment, the nurse notices a transient mottling in the trunk and extremities in response to the cool temperature in the examination room. The infants mother also notices the mottling and asks what it is. The nurse knows that this mottling is called: a Caf au lait. B Carotenemia. C Acrocyanosis. D Cutis marmorata. A 35-year-old pregnant woman comes to the clinic for a monthly appointment. During the assessment, the nurse notices that she has a brown patch of hyperpigmentation on her face. The nurse continues the skin assessment aware that another finding may be: a Keratoses. b Xerosis. c Chloasma. d Acrochordons. A man has come in to the clinic for a skin assessment because he is worried he might have skin cancer. During the skin assessment the nurse notices several areas of pigmentation that look greasy, dark, and stuck on his skin. Which is the best prediction? a Senile lentigines, which do not become cancerous b Actinic keratoses, which are precursors to basal cell carcinoma c Acrochordons, which are precursors to squamous cell carcinoma d Seborrheic keratoses, which do not become cancerous A 72-year-old retired saleswoman comes to your office, complaining of a bloody discharge from her left breast for 3 months. She denies any trauma to her breast. Her past medical history includes high blood pressure and abdominal surgery for colon cancer. Her aunt died of ovarian cancer and her father died of colon cancer. Her mother died of a stroke. The patient denies tobacco, alcohol, or drug use. She is a widow and has three healthy children. On examination her breasts are symmetric, with no skin changes. You are able to express bloody discharge from her left nipple. You feel no discrete masses, but her left axilla has a hard, 1-cm fixed node. The remainder of her heart, lung, abdominal, and pelvic examinations are unremarkable. What cause of nipple discharge is the most likely in her circumstance? A) Benign breast abnormality B) Breast cancer C) Galactorrhea A 51-year-old cook comes to your office for consultation. She recently found out that her 44- year-old sister with premenopausal breast cancer is positive for the BRCA1 gene. Your patient has been doing research on the Internet and saw that her chance of having also inherited the BRCA1 gene is 50%. She is interested in knowing what her risk of developing breast cancer would be if she were positive for the gene. She denies any lumps in her breasts and has had normal mammograms. She has had no weight loss, fever, or night sweats. Her mother is healthy and her father has prostate cancer. Two of her paternal aunts died of breast cancer. She is married. She denies using tobacco or illegal drugs and rarely drinks alcohol. Her breast and axilla examinations are unremarkable. At her age, what is her risk of getting breast cancer if she has the BRCA1 gene? A) 10% B) 50% C) 80% A 14-year-old junior high school student is brought in by his mother and father because he seems to be developing breasts. The mother is upset because she read on the Internet that smoking marijuana leads to breast enlargement in males. The young man adamantly denies using any tobacco, alcohol, or drugs. He has recently noticed changes in his penis, testicles, and pubic hair pattern. Otherwise, his past medical history is unremarkable. His parents are both in good health. He has two older brothers who never had this problem. On examination you see a mildly overweight teenager with enlarged breast tissue that is slightly tender on both sides. Otherwise his examination is normal. He is agreeable to taking a drug test. What is the most likely cause of his gynecomastia? A) Breast cancer B) Imbalance of hormones of puberty C) Drug use A patient is concerned about a dark skin lesion on her anterolateral abdomen. It has not changed, and there is no discharge or bleeding. On examination there is a medium brown circular lesion on the anterolateral wall of the abdomen. It is soft, has regular borders, is evenly pigmented, and is about 7 mm in diameter. What is this lesion? A) Melanoma B) Dysplastic nevus C) Supernumerary nipple D) Dermatofibroma A 30-year-old man notices a firm, 2-cm mass under his areola. He has no other symptoms and no diagnosis of breast cancer in his first-degree relatives. What is the most likely diagnosis? A) Breast tissue B) Fibrocystic disease C) Breast cancer D) Lymph node Which of the following lymph node groups is most commonly involved in breast cancer? A) Lateral B) Subscapular C) Pectoral D) Central When should a woman conduct breast self-examination with respect to her menses? A) Five to seven days following her menses B) Midcycle C) Immediately prior to menses D) During her menses Mrs. Patton, a 48-year-old woman, comes to your office with a complaint of a breast mass. Without any other information, what is the risk of this mass being cancerous? A) About 10% B) About 20% C) About 30% D) About 40% How often, according to American Cancer Society recommendations, should a woman undergo a screening breast examination by a skilled clinician? A) Every year B) Every 2 years C) Every 3 years D) Every 4 years Which of the following is most likely benign on breast examination? A) Dimpling of the skin resembling that of an orange B) One breast larger than the other C) One nipple inverted D) One breast with dimple when the patient leans forward Which is the most effective pattern of palpation for breast cancer? A) Beginning at the nipple, make an ever-enlarging spiral. B) Divide the breast into quadrants and inspect each systematically. C) Examine in lines resembling the back and forth pattern of mowing a lawn. D) Beginning at the nipple, palpate outward in a stripe pattern. Which is true of women who have had a unilateral mastectomy? A) They no longer require breast examination. B) They should be examined carefully along the surgical scar for masses. C) Lymphedema of the ipsilateral arm usually suggests recurrence of breast cancer. D) Women with breast reconstruction over their mastectomy site no longer require examination. Which of the following is true regarding breast self-examination? A) It has been shown to reduce mortality from breast cancer. B) It is recommended unanimously by organizations making screening recommendations. C) A high proportion of breast masses are detected by breast self-examination. D) The undue fear caused by finding a mass justifies omitting instruction in breast self-examination. Which of the following statements is true regarding the internal structures of the breast? The breast is made up of: a Primarily muscle with very little fibrous tissue. B Fibrous, glandular, and adipose tissues. C Primarily milk ducts, known as lactiferous ducts. D Glandular tissue, which supports the breast by attaching to the chest wall. In performing a breast examination, the nurse knows that examining the upper outer quadrant of the breast is especially important. The reason for this is that the upper outer quadrant is: a The largest quadrant of the breast. b The location of most breast tumors. c Where most of the suspensory ligaments attach. d More prone to injury and calcifications than other locations in the breast. In performing an assessment of a woman’s axillary lymph system, the nurse should assess which of these nodes? a Central, axillary, lateral, and sternal b Pectoral, lateral, anterior, and sternal c Central, lateral, pectoral, and subscapular d Lateral, pectoral, axillary, and suprascapular If a patient reports a recent breast infection, then the nurse should expect to find node enlargement. a Nonspecific b Ipsilateral axillary c Contralateral axillary d Inguinal and cervical A 9-year-old girl is in the clinic for a sport physical examination. After some initial shyness she finally asks, Am I normal? I don’t seem to need a bra yet, but I have some friends who do. What if I never get breasts? The nurses best response would be: A Don’t worry, you still have plenty of time to develop. B I know just how you feel, I was a late bloomer myself. Just be patient, and they will grow. C You will probably get your periods before you notice any significant growth in your breasts. d I understand that it is hard to feel different from your friends. Breasts usually develop between 8 and 10 years of age. A patient contacts the office and tells the nurse that she is worried about her 10-year-old daughter having breast cancer. She describes a unilateral enlargement of the right breast with associated tenderness. She is worried because the left breast is not enlarged. What would be the nurses best response? Tell the mother that: a Breast development is usually fairly symmetric and that the daughter should be examined right away. B She should bring in her daughter right away because breast cancer is fairly common in preadolescent girls. C Although an examination of her daughter would rule out a problem, her breast development is most likely normal. D It is unusual for breasts that are first developing to feel tender because they haven’t developed much fibrous tissue. A 14-year-old girl is anxious about not having reached menarche. When taking the health history, the nurse should ascertain which of the following? The age that: a The girl began to develop breasts. B Her mother developed breasts. C She began to develop pubic hair. D She began to develop axillary hair. A woman is in the family planning clinic seeking birth control information. She states that her breasts change all month long and that she is worried that this is unusual. What is the nurses best response? The nurse should tell her that: a Continual changes in her breasts are unusual. The breasts of nonpregnant women usually stay pretty much the same all month long. B Breast changes in response to stress are very common and that she should assess her life for stressful events. C Because of the changing hormones during the monthly menstrual cycle, cyclic breast changes are common. D Breast changes normally occur only during pregnancy and that a pregnancy test is needed at this time. A woman has just learned that she is pregnant. What are some things the nurse should teach her about her breasts? A She can expect her areolae to become larger and darker in color. B Breasts may begin secreting milk after the fourth month of pregnancy. C She should inspect her breasts for visible veins and immediately report these. d During pregnancy, breast changes are fairly uncommon; most of the changes occur after the birth. The nurse is teaching a pregnant woman about breast milk. Which statement by the nurse is correct? A Your breast milk is immediately present after the delivery of your baby. B Breast milk is rich in protein and sugars (lactose) but has very little fat. C The colostrum, which is present right after birth, does not contain the same nutrients as breast milk. D You may notice a thick, yellow fluid expressed from your breasts as early as the fourth month of pregnancy. A 65-year-old patient remarks that she just cannot believe that her breasts sag so much. She states it must be from a lack of exercise. What explanation should the nurse offer her? After menopause: a Only women with large breasts experience sagging. b Sagging is usually due to decreased muscle mass within the breast. c A diet that is high in protein will help maintain muscle mass, which keeps the breasts from sagging. d The glandular and fat tissue atrophies, causing breast size and elasticity to diminish, resulting in breasts that sag. In examining a 70-year-old male patient, the nurse notices that he has bilateral gynecomastia. Which of the following describes the nurses best course of action? a Recommend that he make an appointment with his physician for a mammogram. b Ignore it. Benign breast enlargement in men is not unusual. c Explain that this condition may be the result of hormonal changes, and recommend that he see his physician. d Explain that gynecomastia in men is usually associated with prostate enlargement and recommend that he be thoroughly screened. During an examination of a 7-year-old girl, the nurse notices that the girl is showing breast budding. What should the nurse do next?